| Campins et al. 1414. Campins L, Serra-Prat M, Gózalo I, López D, Palomera E, Agustí C, et al. Randomized controlled trial of an intervention to improve drug appropriateness in community dwelling polymedicated elderly people. Fam Pract 2017; 34:36-42. (2017) |
Spain |
Control: 78.78 (SD: 5.46), 57.4% women Intervention: 79.16 (SD: 5.50), 60.3% women |
START-STOPP, version 2, 2015 |
Intervention (n = 252) Review of each participant’s pharmacotherapy by a clinical pharmacist, using the algorithm for GP-GP and the START-STOPP list to assess potentially inappropriate prescriptions. Presentation of pharmaceutical recommendations (discontinuing, including, replacing or changing the dose of the medication) and definition, together with each patient’s doctor, of the final recommendations. Agreement and implementation of recommendations after discussion between doctor and patient. Control (n = 251) Usual PHC |
After 12 months, it was found that: (1) In the intervention group, 26.5% of prescriptions were classified as potentially inappropriate and 21.5% were optimized according to pharmaceutical recommendations (9.1% suspensions, 6.9% adjusted doses, 3.2% substitutions and 2.2% medication inclusions); (2) There were no significant differences between the intervention and control groups regarding the number of: emergency department visits (mean, SD): 0.9 (1.5) vs. 1.1 (1.5), p = 0.061; hospitalizations (n, %): 57 (23.3) vs. 63 (25.2), p = 0.616; deaths (n, %): 7 (2.8) vs. 6 (2.4), p = 0.784 |
The pharmacotherapy review using the GP-GP algorithm and the START/STOPP list reduced the number of prescribed drugs and improved the prescription appropriateness profile, but did not reduce emergency room visits, hospitalizations, and death in polymedicated (≥ 8 medications) older adults (≥ 70 years old) |
| Campins et al. 1515. Campins L, Serra-Prat M, Palomera E, Bolibar I, Martínez MÀ, Gallo P. Reduction of pharmaceutical expenditure by a drug appropriateness intervention in polymedicated elderly subjects in Catalonia (Spain). Gac Sanit 2019; 33:106-11. (2019) |
Spain |
Intervention: 79.1 (SD: 5.4), 61.6% women Control: 78.7 (SD: 5.5), 57.9% women |
START-STOPP, version 2, 2015 |
Intervention (n = 245) Review of each participant’s pharmacotherapy by a clinical pharmacist, using the algorithm for GP-GP and the START-STOPP list to assess potential inappropriate prescriptions. Presentation of pharmaceutical recommendations (discontinuing, including, replacing or changing the dose of the medication) and definition, together with each patient’s doctor, of the final recommendations. Agreement and implementation of recommendations after discussion between doctor and patient. Control (n = 245) Usual PHC |
After 12 months, the following was found: (1) A significantly greater reduction in annual medication expenditure in the intervention group than in the control group (-14.3% vs. -7.7%, p = 0.041); (2) A reduction in annual medication expenditure of EUR 233.75/patient (95%CI: 169.83; 297.67) in the intervention group and EUR 169.40/patient (95%CI: 103.37; 235.43) in the control group, indicating an annual saving of EUR 64.30/patient attributable to the intervention; (3) An estimated return of EUR 2.38 per Euro invested in the intervention program |
The study showed that the intervention (prescription review by a clinical pharmacist) for polymedicated (≥ 8 medications) older patients (≥ 70 years) followed-up in PHC resulted in an annual reduction of approximately 7% in medication expenditures, suggesting a possible return on investment for the intervention |
| Willeboordse et al. 1616. Willeboordse F, Schellevis FG, Chau SH, Hugtenburg JG, Elders PJM. The effectiveness of optimised clinical medication reviews for geriatric patients: Opti-Med a cluster randomised controlled trial. Fam Pract 2017; 34:437-45. (2017) |
Netherlands |
Intervention: 77.8 (SD: 7.7), 64.4% women Control: 77.8 (SD: 8.0), 65.4% women |
START-STOPP, version 1, 2008 |
Intervention (n = 275) Data collection from electronic medical records in PHC, from the pharmacy and from the screening questionnaire sent to the participants. Review of pharmacotherapy by a group of experts, consisting of a physician or nurse and a clinical pharmacist, using an adapted and electronic version of the STRIP, which includes the START-STOPP criteria. Sending the pharmacotherapeutic care plan, defined by the group of specialists, to the PHC physician. Agreement and implementation of the care plan after discussion between doctor and patient. Implemented recommendations were reported electronically to the pharmacy. Control (n = 243) Usual PHC. Data collection from the electronic medical record in PHC, from the pharmacy and from the screening questionnaire sent to the participants, and pharmacotherapy review by the group of specialists, but the doctor and patient did not receive the results of the analysis |
After 6 months: (1) There was a higher number (%) of resolved ADE in the intervention group than in the control group (regression coefficient B: 22.6, 95%CI: 14.1; 31.1, p < 0.001). (2) There was no significant difference between the control and intervention groups in terms of self-reported quality of life based on the SF-12 and EQ5D-3L questionnaires (p > 0.05). (3) There were no significant differences between the intervention and control groups in terms of resolution (OR = 0.99, 95%CI: 0.62; 1.57, p = 0.96) and perception of severity (OR = 1.09, 95%CI: 0.73; 1.63, p = 0.67) of the main geriatric syndromes |
The pharmacotherapy review based on the STRIP method and carried out by a group of specialists, including a clinical pharmacist, increased the resolution of DRP in the intervention group, but did not influence the course of the main geriatric syndromes or the perception of quality of life in polymedicated older patients in PHC |
| Lenander et al. 1717. Lenander C, Elfsson B, Danielsson B, Midlöv P, Hasselström J. Effects of a pharmacist-led structured medication review in primary care on drug-related problems and hospital admission rates: a randomized controlled trial. Scand J Prim Health Care 2014; 32:180-6. (2014) |
Sweden |
Intervention: 79.0 (SD: 77.8; 80.2), 65.4% women Control: 79.7 (SD: 78.4; 81.1), 68.6% women |
Beers (1997) |
Intervention (n = 107) Questionnaire on medication use and DRP sent to participants. Analysis of responses and pharmacotherapy review by a certified clinical pharmacist, using the Beers Criteria (1997) and the model of pharmaceutical care by Strand et al. 4343. Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. DICP 1990; 24:1093-7. to identify and classify DRP. Blind data analysis by another independent clinical pharmacist. Presentation of pharmaceutical recommendations to patients prior to physician consultation. After 12 months, the questionnaire was sent back to the participants for comparison with the pre-intervention period. Control (n = 102) Submission of the questionnaire on medication use at baseline and after 12 months. Usual in PHC |
After 12 months, the following was found: (1) A significant reduction in the number of DRP per patient in the intervention group, from 1.73 (95%CI: 1.42; 2.05) at baseline to 1.31 (95%CI: 1.02; 1.59) 6 months after the intervention, p = 0.02. (2) A significant reduction in the number of medications in the intervention group (from 8.6 to 7.9, p < 0.05), but not in the control group (from 7.4 to 7.5). (3) The mean number of hospital admissions was higher in the control group than in the intervention group (mean: 2.7 vs. 1.7; median: 2 vs. 1), as was the length of stay (mean: 18 vs. 12 days; median: 1.25 vs. 6 days); however, no significant differences were observed between the intervention and control groups. (4) Self-rated general health (scale from 1 to 5) remained unchanged in the intervention group, while in the control group there was a decrease in the score (p < 0.02), resulting in a significant difference between the groups, p = 0.047 |
The structured pharmacotherapy review performed by a qualified pharmacist helps to reduce the number of medications and prevent the decline in self-rated health in polymedicated (≥ 5 medications) older adults (≥ 65 years old) monitored in PHC |
| Clyne et al. 1818. Clyne B, Smith SM, Hughes CM, Boland F, Bradley MC, Cooper JA, et al. Effectiveness of a multifaceted intervention for potentially inappropriate prescribing in older patients in primary care: a cluster-randomized controlled trial (OPTI-SCRIPT study). Ann Fam Med 2015; 13:545-53. (2015) |
Ireland |
Intervention: 77.1 (SD: 4.9), 55.6% men Control: 76.4 (SD: 4.8), 51.5% men |
OPTI-SCRIPT study with a list of potentially inappropriate drugs based on STOPP criteria |
Intervention (n = 99) Academic detailing in 30-minute sessions between a clinical pharmacist and a general practitioner to review the pharmacotherapy of the patients included in the study. Prescription analyses were performed using a database with treatment algorithms containing evidence-based alternatives to PIM and PIP. Preparation of specific pamphlets (tailor-made) for patients with information on the PIM identified in the prescriptions. Control (n = 97) Usual PHC |
After 12 months, the following was found: (1) A lower number (%) of patients with PIP in the intervention group than in the control group (52% vs. 77%), confirmed by relative risk (OR = 0.32, 95%CI: 0.15; 0.70, p = 0.02). (2) A lower number (mean) of PIP per patient in the intervention group than in the control group (0.70 vs. 1.18), with an incidence rate = 0.71 (95%CI: 0.50; 1.02), p = 0.49. (3) No significant difference in the WBQ-12 results between the intervention and control groups (23.6 vs. 24.0, mean: 0.41, 95%CI: -0.80; 1.07, p = 0.99) |
The intervention of the OPTI-SCRIPT study reduced the number of PIP, mainly with proton pump inhibitors, but did not influence the beliefs about the medications or the perception of well-being of the older adults followed in PHC |
| Gillespie et al. 1919. Gillespie P, Clyne B, Raymakers A, Fahey T, Hughes CM, Smith SM. Reducing potentially inappropriate prescribing for older people in primary care: cost-effectiveness of the OPTI-SCRIPT intervention. Int J Technol Assess Health Care 2017; 33:494-503. (2017) |
Ireland |
Intervention: 77.1 (SD: 4.9), 55.6% men Control: 76.4 (SD: 4.8), 51.5% men |
OPTI-SCRIPT study with a list of potentially inappropriate drugs based on STOPP criteria |
Intervention (n = 99) Academic detailing, in 30-minute sessions, between a clinical pharmacist and a general practitioner to review the pharmacotherapy of the patients included in the study. Prescription analyses were carried out using a database with treatment algorithms containing evidence-based alternatives to PIM and PIP. Preparation of specific pamphlets (tailor-made) for patients with information on the PIM identified in the prescriptions. Control (n = 97) Usual care |
After 12 months, the following was found: (1) A non-significant increase in mean health care costs in the intervention group compared to the control group: EUR 3,075 (95%CI: 2,704; 3,446) vs. EUR 2,668 (95%CI: 2,297; 3,040). (2) A significant reduction in mean PIP in the intervention group compared to the control group: EUR 0.627 (95%CI: 0.588; 0.666) vs. EUR 1.006 (95%CI: 0.967; 1.045). (3) A nonsignificant increase in mean QALYs in the intervention group compared to the control group: EUR 0.671 (95%CI: 0.625; 0.716) vs. EUR 0.657 (95%CI: 0.612; 0.703). (4) An ICER per PIP averted of EUR 1,269 (95%CI: -1,400; 6,302) and an ICER per QALY gained of EUR 30,535 (95%CI: -334,846; 289,498) |
Although the OPTI-SCRIPT study intervention was effective in reducing PIP in PHC in Ireland, the results of this study highlight the uncertainty regarding the cost-effectiveness of implementing the intervention in the service |
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PIM: potentially inappropriate medications.
RCT: randomized clinical trial. Note: red - high risk of bias, yellow - unknown risk of bias, and green - low risk of bias.
95%CI: 95% confidence interval; OR: odds ratio.